Hostname: page-component-6766d58669-76mfw Total loading time: 0 Render date: 2026-05-20T21:32:44.950Z Has data issue: false hasContentIssue false
  • English
  • Français

Exposure to Pulmonary Tuberculosis in a Neonatal Intensive Care Unit: Unique Aspects of Contact Investigation and Management of Hospitalized Neonates

Published online by Cambridge University Press:  02 January 2015

Joseph Jacob Nania ,
Jena Skinner ,
Kathie Wilkerson ,
Jon V. Warkentin ,
Valerie Thayer ,
Melanie Swift ,
William Schaffner  and
Thomas R. Talbot
Joseph Jacob Nania*
Affiliation:
Division of Pediatric Infectious Diseases and Department of Pediatrics, Nashville, Tennessee
Jena Skinner
Affiliation:
Vanderbilt University School of Medicine, the Department of Infection Control and Prevention, Nashville, Tennessee
Kathie Wilkerson
Affiliation:
Vanderbilt University School of Medicine, the Department of Infection Control and Prevention, Nashville, Tennessee
Jon V. Warkentin
Affiliation:
Vanderbilt University Medical Center, and the Tennessee Department of Health, Nashville, Tennessee
Valerie Thayer
Affiliation:
Occupational Health Clinic, Nashville, Tennessee
Melanie Swift
Affiliation:
Department of Medicine, Nashville, Tennessee Occupational Health Clinic, Nashville, Tennessee
William Schaffner
Affiliation:
Department of Medicine, Nashville, Tennessee Department of Preventive Medicine, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Department of Medicine, Nashville, Tennessee Department of Preventive Medicine, Nashville, Tennessee
*
1161 21st Avenue South, D-7235 Medical Center North, Nashville, Tennessee 37232 (Jake.nania@vanderbilt.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

We describe the investigation of a tuberculosis (TB) exposure in which a neonatal intensive care unit (NICU) respiratory therapist was the index patient, as well as the rationale by which exposed infants were managed and possible explanations for the lack of transmission to these patients.

Design.

Description of an exposure investigation.

Setting.

Academic, level IV NICU of a tertiary care children's hospital.

Participants.

Contacts of a respiratory therapist with pulmonary TB disease, including household members, healthcare coworkers, and infant patients.

Results.

In addition to 5 household contacts, 248 healthcare coworkers and 180 infant patients were identified as possibly exposed during the 24 days that the index patient worked between December 3, 2004, and January 30, 2005. Tuberculin skin tests (TSTs) were performed for 233 of the 235 contacts with the greatest degree of exposure (household and coworker contacts) who had a previously documented negative TST result or whose TST status was unknown prior to the investigation. No cases of latent tuberculosis infection or TB disease were identified. Because of characteristics of the index case, the exposure duration and setting, the infants' small lung volumes, and lack of evidence of transmission to higher-risk contacts, infants were not clinically evaluated or empirically treated for TB disease. Surveillance for subsequent illness was carried out by primary healthcare providers and parents. No TB disease or unexplained illness in these infants was reported in the 20 months following the exposure.

Conclusion.

After limited hospital exposure to a healthcare worker with pulmonary TB disease who is not highly contagious, neonates can be safely managed without specific evaluation for TB disease or empirical treatment.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 661 - 665
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Taylor, Z, Nolan, CM, Blumberg, HM. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recomtn Rep 2005;54(RR-12):1–81.Google ScholarPubMed
2.Etkind, S, Veen, J. Contact follow-up in high- and low-prevalence countries. In: Reichman, LB, ed. Tuberculosis: A Comprehensive International Approach. 2nd ed. New York: Marcel Dekker Inc., 2000:377–399.Google Scholar
3.Sen, M, Gregson, D, Lewis, J. Neonatal exposure to active pulmonary tuberculosis in a health care professional. CMAJ 2005;172:1453–1456.Google Scholar
4.Light, IJ, Saidleman, M, Sutherland, JM. Management of newborns after nursery exposure to tuberculosis. Am Rev Respir Dis 1974;109:415–419.Google Scholar
5.Burk, JR, Bahar, D, Wolf, FS, Greene, J, Bailey, WC. Nursery exposure of 528 newborns to a nurse with pulmonary tuberculosis. South Med J 1978;71:7–10.Google Scholar
6.Keim, LW. Letter: Management of newborns after nursery exposure to tuberculosis. Am Rev Respir Dis 1974;110:522–523.Google Scholar
7.Steiner, P, Rao, M, Victoria, MS, Rudolph, N, Buynoski, G. Miliary tuberculosis in two infants after nursery exposure: epidemiologie, clinical, and laboratory findings. Am Rev Respir Dis 1976;113:267–271.Google Scholar
8.Mycobacterium tuberculosis transmission in a newborn nursery and maternity ward—New York City, 2003. MMWR Morb Mortal Wkly Rep 2005;54:1280–1283.Google Scholar
9.Nivin, B, Nicholas, P, Gayer, M, Frieden, TR, Fujiwara, PI. A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clin Infect Dis 1998;26:303–307.CrossRefGoogle Scholar
10.Reichler, MR, Reves, R, Bur, S, et al.Evaluation of investigations conducted to detect and prevent transmission of tuberculosis. JAMA 2002;287:991–995.Google Scholar
11.Marks, SM, Taylor, Z, Quails, NL, Shrestha-Kuwahara, RJ, Wilce, MA, Nguyen, CH. Outcomes of contact investigations of infectious tuberculosis patients. Am J Respir Crit Care Med 2000;162:2033–2038.Google Scholar
12.Bailey, WC, Gerald, LB, Kimerling, ME, et al.Predictive model to identify positive tuberculosis skin test results during contact investigations. JAMA 2002;287:996–1002.CrossRefGoogle ScholarPubMed
13.Liippo, KK, Kulmala, K, Tala, EO. Focusing tuberculosis contact tracing by smear grading of index cases. Am Rev Respir Dis 1993;148:235–236.Google Scholar
14.Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005;54(RR-15): 1–47.Google Scholar
15.Gerald, LB, Tang, S, Bruce, F, et al.A decision tree for tuberculosis contact investigation. Am J Respir Crit Care Med 2002;166:1122–1127.Google Scholar
16.Catanzaro, A. Nosocomial tuberculosis. Am.Rev Respir Dis 1982;125:559–562.Google Scholar
17.Vallejo, JG, Ong, LT, Starke, JR. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics 1994;94:1–7.Google Scholar
18.Hussey, G, Chisholm, T, Kibel, M. Miliary tuberculosis in children: a review of 94 cases. Pediatr Infect Dis J 1991;10:832–836.Google Scholar
19.Gessner, BD, Weiss, NS, Nolan, CM. Risk factors for pediatric tuberculosis infection and disease after household exposure to adult index cases in Alaska. J Pediatr 1998;132:509–513.Google Scholar
20.Marais, BJ, Gie, RP, Schaaf, HS, Beyers, N, Donald, PR, Starke, JR. Childhood pulmonary tuberculosis: old wisdom and new challenges. Am J Respir Crit Care Med 2006;173:1078–1090.CrossRefGoogle ScholarPubMed
21.Luce, IM. Respiratory monitoring in critical care. In: Cecil, RL, Goldman, L, Bennett, JC, eds. Cecil Textbook of Medicine. 22nd ed. Philadelphia: W.B. Saunders, 2004:598–602.Google Scholar
22.Madhi, F, Fuhrman, C, Monnet, I, et al.Transmission of tuberculosis from adults to children in a Paris suburb. Pediatr Pulmonol 2002;34:159–63.Google Scholar
23.Soysal, A, Millington, KA, Bakir, M, et al.Effect of BCG vaccination on risk of Mycobacterium tuberculosis infection in children with household tuberculosis contact: a prospective community-based study. Lancet 2005;366:1443–1451.Google Scholar
24.Jensen, PA, Lambert, LA, Iademarco, MF, Ridzon, R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54:1–141.Google Scholar